The St. Mary's/Duluth Clinic Health System (SMDC Health System) formerly known as the Duluth Clinic has worked for the past twenty three years to develop a multidisciplinary organization involved in the care of oncology patients and to function as a cancer research unit for the region. St. Mary's Medical Center, the only tertiary care hospital in our region, and Duluth Clinic, the largest multispecialty physician group practice in our region, merged in January 1997 to become SMDC Health System. The Duluth Clinic was a founding member of the North Central Cancer Treatment Group in 1977 and has functioned as a CCOP since 1984. During this time, the Duluth CCOP has entered patients onto numerous clinical trials, has assisted in the development of new programs, served as chair or co-chair on numerous protocols, and has presented at national meetings. An excellent working relationship exists with the cooperative groups and data of excellent quality is generated as shown by past audit performance records. Geographically, the Duluth CCOP is the main source providing the benefits of clinical cancer research to this large geographic area. The Northwestern Ontario Regional Cancer Centre, Ontario, Canada, a component of the Duluth CCOP covers a large area also. This is a unique relationship in that the two components are two separate cancer centers, have two separate patient populations and are in two different countries. Our strategy is to continuously offer the advantages of clinical research to patients in the catchment/service area and to increase efforts in cancer prevention, cancer control and cancer rehabilitation. The North Central Cancer Treatment Group functions as the primary research base and the secondary research bases are the Eastern Cooperative Oncology Group, the Children's Cancer Group, the National Surgical Adjuvant Breast and Bowel Project and just recently the Southwest Oncology Group. The goal of the CCOP is to accrue over 120 patients per year onto cancer treatment protocols and 200 patients to cancer prevention and control programs per year. By virtue of the already established programs and the commitment to quality, it is believed that a high level of productivity and quality can be maintained.